Teaching personal awareness


Educators rarely consider the attitudes that determine whether a learner will use the clinical skills we teach. Nevertheless, many learners and practitioners exhibit negative attitudes that can impede the use of patient-centered skills, leading to an isolated focus upon disease and impairing the provider-patient relationship. The problem is compounded because these attitudes often are incompletely recognized by learners and therefore are difficult to change without help.

We present a research-based method for teaching personal awareness of unrecognized and often harmful attitudes. We propose that primary care clinicians without mental health training can follow this method to teach students, residents, faculty, and practitioners. Such teachers/mentors need to possess an abiding interest in the personal dimension, patience with a slowly evolving process of awareness, and the ability to establish strong, ongoing relationships with learners. Personal awareness teaching may occur during instruction in basic interviewing skills but works best if systematically incorporated throughout training.

This is a preview of subscription content, access via your institution.


  1. 1.

    Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997;278:502–9.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Smith RC, Dorsey AM, Lyles JS, Frankel RM. Teaching self-awareness enhances learning about patient-centered interviewing. Acad Med. 1999;74:1242–8.

    PubMed  CAS  Google Scholar 

  4. 4.

    Smith RC. Use and management of physicians’ feelings during the interview. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview. New York, NY: Springer-Verlag; 1995:104–9.

    Google Scholar 

  5. 5.

    Smith RC. Teaching interviewing skills to medical students: the issue of ‘countertransference’. J Med Educ. 1984;59:582–8.

    PubMed  CAS  Google Scholar 

  6. 6.

    Smith RC. Unrecognized responses by physicians during the interview. J Med Educ. 1986;61:982–4.

    PubMed  CAS  Google Scholar 

  7. 7.

    Gorlin R, Zucker HD. Physicians’ reactions to patients: a key to teaching humanistic medicine. N Engl J Med. 1983;308:1059–63.

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Johnson AH. Assessing counselling skills and attitudes in family practice. J Fam Pract. 1979;9:447–52.

    PubMed  CAS  Google Scholar 

  9. 9.

    Schildkrout E. Medical residents’ difficulty in learning and utilizing a psychosocial perspective. J Med Educ. 1980;55:962–4.

    PubMed  CAS  Google Scholar 

  10. 10.

    Sherer LM, Johnson AH. Resident development in family practice training: a personal counselling program. J Fam Pract. 1980;10:1017–23.

    PubMed  CAS  Google Scholar 

  11. 11.

    Ekstein R, Wallerstein RS. The Teaching and Learning of Psychotherapy, 2nd ed. New York, NY: International Universities Press; 1972.

    Google Scholar 

  12. 12.

    Schuster DB, Sandt JJ, Thaler OF. Clinical Supervision of the Psychiatric Resident. New York, NY: Brunner/Mazel; 1972.

    Google Scholar 

  13. 13.

    Smith RC, Marshall AA, Cohen-Cole SA. The efficacy of intensive biopsychosocial teaching programs for residents: a review of the literature and guidelines for teaching. J Gen Intern Med. 1994;9:390–6.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Palmer PJ. Reflections on a Program for “The Formation of Teachers.” An occasional paper of the Fetzer Institute, Kalamazoo, MI; 1992.

    Google Scholar 

  15. 15.

    Lipkin JM, Kaplan C, Clark W, Novack D. Teaching medical interviewing: the Lipkin model. In: Lipkin M, Putnam SM, Lazare A, eds. The Medical Interview. New York, NY: Springer-Verlag; 1995;422–35.

    Google Scholar 

  16. 16.

    Marshall AA, Smith RC. Physicians’ emotional reactions to patients: recognizing and managing countertransference. Am J Gastroenterol. 1995;90:4–8.

    PubMed  CAS  Google Scholar 

  17. 17.

    Smith RC. Teaching Supplement for ‘The Patients’ Story—Integrated Patient-Doctor Interviewing’. B306 Clinical Center, Michigan State University, East Lansing, MI: Author. 1996.

    Google Scholar 

  18. 18.

    Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74:516–20.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Smith RC, Zimny G. Physicians’ emotional reactions to patients. Psychosomatics. 1988;29:392–7.

    PubMed  CAS  Google Scholar 

  20. 20.

    Mitchell SA. Relational Concepts in Psychoanalysis—An Integration. Cambridge, MA: Harvard University Press; 1988.

    Google Scholar 

  21. 21.

    Mitchell SA. Relationality. Hillsdale, NJ: The Analytic Press; 2000.

    Google Scholar 

  22. 22.

    Rogers CR. On Becoming a Person. Boston, MA: Houghton-Mifflin; 1961.

    Google Scholar 

  23. 23.

    Rogers CR. The characteristics of a helping relationship. Personnel and Guidance Journal. 1958;37:6–16.

    Google Scholar 

  24. 24.

    Rogers CR. Client-centered Therapy. Boston, MA: Houghton Mifflin Company; 1951.

    Google Scholar 

  25. 25.

    Smith RC, Lyles JS, Mettler J, et al. The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med. 1998;128:118–26.

    PubMed  CAS  Google Scholar 

  26. 26.

    Smith RC, Osborn G, Hoppe RB, et al. Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study. J Gen Intern Med. 1991;6:535–43.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Smith RC, Mettler JA, Stoffelmayr BE, et al. Improving residents’ confidence in using psychosocial skills. J Gen Intern Med. 1995;10:315–20.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Smith RC, Lyles JS, Mettler JA, et al. A strategy for improving patient satisfaction by the intensive training of residents in psychosocial medicine: a controlled, randomized study. Acad Med. 1995;70:729–32.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Hall JA, Roter DL, Milburn MA. Illness and satisfaction with medical care. Curr Direct Psychol Sci. 1999;8:96–9.

    Article  Google Scholar 

  30. 30.

    Palmer PJ. The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life. San Francisco, CA: Jossey-Bass; 1998.

    Google Scholar 

  31. 31.

    Williamson PR, Smith RC, Kern DE, et al. The medical interview and psychosocial aspects of medicine: block curricula for residents. J Gen Intern Med. 1992;7:235–42.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Smith RC, Marshall-Dorsey AA, Osborn GG, et al. Evidence-based guidelines for teaching patient-centered interviewing. Patient Educ Couns. 2000;39:27–36.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Fortin AH VI, Haeseler FD, Angoff N, et al. Teaching pre-clinical medical students an integrated approach to medical interviewing—half-day workshops using actors. J Gen Intern Med. 2002;17:704–8.

    PubMed  Article  Google Scholar 

  34. 34.

    Fortin AH VI. Communication skills to improve patient satisfaction and quality of care. Ethn Dis. 2002;12(suppl 3):58–61.

    Google Scholar 

  35. 35.

    Smith RC. Videotape of Evidence-based Interviewing: 1) Patient-centered Interviewing and 2) Doctor-centered Interviewing. Available at: http://www.msuvmall.msu.edu/imc. Accessed February 27, 2004.

  36. 36.

    Smith RC. Patient-centered Interviewing: An Evidence-based Method, 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2002.

    Google Scholar 

  37. 37.

    Knowles MS. The Modern Practice of Adult Education: From Pedagogy to Andragogy. New York, NY: Cambridge, The Adult Education Company; 1980.

    Google Scholar 

  38. 38.

    Yalom ID. The Theory and Practice of Group Psychotherapy, 3rd ed. New York, NY: Basic Books, Inc.; 1985.

    Google Scholar 

  39. 39.

    Shapiro J. How do physicians teach empathy in the primary care setting? Acad Med. 2002;77:323–8.

    PubMed  Article  Google Scholar 

  40. 40.

    Balint M. The Doctor, His Patient, and the Illness, Revised ed. New York, NY: International Universities Press; 1957.

    Google Scholar 

  41. 41.

    Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–81.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Engel GL. White coats, intimacy, and medicine as a human science. Presentation to the Program for Biopsychosocial Studies. The University of Rochester School of Medicine and Dentistry; Rochester, NY; June 3 1994.

    Google Scholar 

  43. 43.

    Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd ed. New York, NY: Guilford Press; 2002.

    Google Scholar 

  44. 44.

    Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif. 1992;28:183–218.

    PubMed  CAS  Google Scholar 

  45. 45.

    Kernberg O. Notes on countertransference. J Am Psychoanal Assoc. 1965;13:38–56.

    PubMed  CAS  Article  Google Scholar 

  46. 46.

    Matthews DA, Suchman AL, Branch WT. Making “connexions”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 1993;118:973–7.

    PubMed  CAS  Google Scholar 

  47. 47.

    Cole KA, Barker LR, Kolodner K, Williamson P, Wright SM, Kern DE. Faculty development in teaching skills: an intensive longitudinal model. Acad Med. 2004;79:469–80.

    PubMed  Article  Google Scholar 

  48. 48.

    Olson J, Kent K, Lein CE, Smith RC. Role of resident attitudes in learning and using skills in patient-centered interviewing. Semin Med Pract. 2002;5:3–12.

    Google Scholar 

  49. 49.

    Scheingold L. Balint work in England: lessons for American family medicine. J Farm Pract. 1988;26:315–20.

    CAS  Google Scholar 

  50. 50.

    Courtenay MJF. A plain doctor’s guide to Balint-work. J Balint Soc. 1992;20:20–1.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr. Robert C. Smith MD, ScM.

Additional information

The authors are aware of no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Smith, R.C., Dwamena, F.C. & Fortin, A.H. Teaching personal awareness. J GEN INTERN MED 20, 201–207 (2005). https://doi.org/10.1111/j.1525-1497.2005.40212.x

Download citation

Key words

  • self-awareness
  • countertransference
  • attitudes
  • provider-patient relationship
  • communication
  • medical education